Calling all doctors, any doctors ... please

Governor proposes loan payoff reward for upstate N.Y. job

Published 4:00 am, Sunday, February 24, 2008

In secluded corners of upstate New York and impoverished neighborhoods around New York City, the sick are less likely to see a doctor.

Hours from a big city, and a helicopter ride away from certain specialized medical treatments, Adirondack Medical Center is one of New York's medical outposts, struggling to compete with large metropolitan teaching hospitals when it comes to hiring physicians.

"It's what keeps us awake at night," CEO Chandler Ralph said. "How are we going to get enough doctors to take care of our community?"

That question could be answered with a new idea Gov. Eliot Spitzer announced as part of his executive budget. He's proposing an initiative to pay off student loans for doctors as a reward for working in underserved areas.

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At least 45 states have loan repayment programs in varying amounts for doctors who practice in underserved and rural areas, according to the National Conference of State Legislatures. Some of those are completely federally funded, while others use state and private contributions.

The average physician in the United States graduating in 2006 had $130,571 in student loan debt, according to the American Medical Association. For New Yorkers graduating from a state public school, the Spitzer administration said, that average is $129,000. The average debt is $160,000 for those who attend private universities in New York.

More than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, the AMA said.

The California Physician Corps Loan Prepayment Program encourages recently licensed physicians to practice in underserved locations and pays their educational loans - up to $105,000 - in exchange for at least three years of work in a needy area.

In Montana, doctors can receive up to $45,000 toward their educational debt, depending on how long they work in the underserved regions. The Rural Partnership, a nonprofit organization in Nashville, has taken matters into its own hands, offering up to a $25,000 stipend to attract doctors and match them to openings.

The Doctors Across New York initiative is supposed to help the more than 25 percent of New York's population who live in areas designated as underserved.

It would set aside $2 million a year to create a physician loan repayment program that would help as many as 100 doctors each year. If the doctor stays in an underserved area for the minimum requirement of two years, 30 percent of the loan would be paid off. Payments would grow each year to the point where it would be paid off after five years. The repayment maxes out at $150,000.

The state Department of Health estimates that underserved areas need more than 300 primary care physicians just to escape the classification of "health professional shortage areas," defined as more than 3,500 people for each physician.

In parts of New York City - within an hour of some of the best medical care in the world - the poor have limited access to care, or at least quality care, because of doctor shortages.

"The salaries are poor, the neighborhoods are poor, and it's not really an attractive place for people to go and work," said Dr. Marcelo Venegas-Pizzarro, the chief medical officer for Housing Works, a nonprofit organization that cares for the poor, homeless and those living with HIV.

The need is great. In some cases, doctors who work in these areas do it because they want to serve needy populations, but that's not always the case, Venegas-Pizzarro said.

"You see doctors that aren't top-notch doctors working in underserved areas because they can't get other work," he said.

Surrounded by sprawling woods and mountains, Saranac Lake is beautiful but isolated and, in winter, one of the coldest spots in the state. Adirondack Medical Center is based there, but has five satellite offices in the region.

The Saranac Lake hospital is modern, but homespun touches - like frames displaying nearly two decades of fish lures and arrows that had once been embedded in emergency room patients - are a reminder that this is a country community of just 5,000 people.

The center needs to hire six doctors in various specialties. It has 48 physicians now, but it's a hostile recruiting environment. One doctor who was earning $150,000 a year was lost to a Seattle practice that paid him $450,000 - plus a $50,000 signing bonus.

As things are now, half of all resident physicians leave New York state after completing their training.

At the Adirondack Medical Center, it can take more than a year to fill an empty position, Ralph said. Sometimes hospitals hire physicians to work as "temps" for as long as six months, but it costs 30 to 50 percent more.

"We had to cut back on taking new patients here for a while because we had very limited physician time," Charles said. "So that means patients had to do things like go to the emergency room in the hospital, which is a much more expensive visit."

Spitzer's plan could bring the relief that rural and inner-city hospitals need. But hospital administrators will have to cross their fingers until the final budget comes out.